Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Little is known about how accelerated discharge strategies compare with established enhanced recovery pathways after endoscopic endonasal surgery (EES). This study aimed to evaluate the efficacy and safety of an accelerated discharge protocol after EES. METHODS:This was a retrospective analysis of adults who underwent EES for pituitary adenomas at a single academic center between 2012 and 2025. Patients were managed under 1 of 4 postoperative pathways dependent on year of surgery: (1) No institutional protocol; (2) First-generation recovery protocol; (3) Enhanced recovery after surgery (ERAS); and (4) Expedited one-day discharge. Demographic and clinical variables were extracted from the electronic medical record using automated natural-language-processing methods. Primary outcomes were length of stay (LOS) and 30-day all-cause readmission or reoperation. All data processing, visualization, and statistical analyses were performed using Python version 3.12. RESULTS:Six hundred patients who underwent 630 surgeries were included. Median LOS was 3 days, with a 30-day readmission rate of 14.3% and a 30-day postdischarge reoperation rate of 2.5%. LOS differed significantly across protocol eras, with progressively shorter hospital stays observed over time and the shortest median stay occurring under the expedited discharge protocol (P < .0001). Readmission rates were highest in the preprotocol (16.2%) and initial protocol periods (17.2%), declining to 8.3% under the ERAS protocol and 10.0% under the expedited discharge protocol (P = .039). 30-day postdischarge reoperation rates did not statistically differ across protocols. In multivariate analyses, both the ERAS (rate ratio = 0.899, P = .021) and expedited discharge protocols (rate ratio = 0.819, P = .024) demonstrated significantly shorter hospital stays compared with the preprotocol era, without differences in 30-day readmission or reoperation rates. CONCLUSION/CONCLUSIONS:The expedited discharge protocol safely shortened hospital stays without increasing 30-day readmissions or reoperations. These findings support the feasibility of accelerated postoperative pathways after EES. Broad adoption has the potential to produce substantial resource savings without compromising patient safety.

The endoscopic transsphenoidal approach (ETSA) is a commonly used technique that allows for the minimally invasive removal of sellar and parasellar lesions. Augmented reality (AR) applications in ETSA are hypothesized to enhance intraoperative visualization by integrating a 3D-reconstructed model into the operative field. This study describes the workflow and surgical outcomes associated with the Endoscopic Surgical Navigation Advanced Platform (EndoSNAP, Surgical Theater, Cleveland, OH, USA), an AR platform designed for surgical planning and intraoperative navigation in ETSA for sellar and parasellar lesions. We analyzed a cohort of patients who underwent ETSA tumor resection using EndoSNAP. Preoperative MRI and CT scans were reconstructed and merged into a single 360° AR model using the Surgical Rehearsal Platform software. The model was then imported into EndoSNAP, which was integrated with the endoscope and neuronavigation system for real-time intraoperative use. Patient demographics, tumor characteristics, extent of resection (EOR), and endocrinologic and neurologic outcomes were recorded. Eighteen adult patients with newly diagnosed (83%) and recurrent (17%) tumors were included. Pathologies consisted of pituitary adenoma (72%), craniopharyngioma (11%), meningioma (11%), and chordoma (6%). Optic compression was present in 56% of patients, with preoperative visual deficits in 70% of them. Cavernous sinus invasion was observed in 17% of tumors. Preoperative hormonal excess and insufficiency were noted in 56% and 28% of cases, respectively. The mean preoperative tumor volume was 21.4 ± 17 cm³, which decreased to 0.4 ± 0.3 cm³ postoperatively. The mean EOR was 93.6 ± 3.6%. Postoperative complications included CSF leaks requiring surgical repair (17%), seizures related to pre-existing hemispheric trauma (6%), pulmonary embolism (6%), deep venous thrombosis (6%), and sinusitis (6%). These findings suggest that AR-enhanced visualization through EndoSNAP is a feasible and potentially beneficial adjunct in ETSA for sellar and parasellar tumor resection.

Soon after the World Health Organization declared the severe acute respiratory syndrome coronavirus 2 a global health emergency on January 30, 2020, New York City was plagued by the virus and its health system and economy pushed to their limits. The majority of the limited neurosurgical data in relation to COVID-19 is anecdotal and the higher theoretical risk of transmission of the virus among skull base aerosol generating (SBAG) cases has not been investigated or discussed in a neurosurgical population. We discuss a series of 13 patients who underwent 15 SBAG surgical procedures during the peak of COVID-19 in our hospital system and the protocols use perioperatively for their procedures. Our data support that with proper preoperative testing, a well-delineated surgical algorithm, and appropriate personal protective equipment, emergent/urgent cases can be done safely in hospitals that are currently experiencing high volumes of COVID-19 cases as we did in March to May of 2020.

BACKGROUND:Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is 0.7%-3%. A variety of methods exist to minimize the risk of meningitis with antibiotic prophylaxis, although their value is not completely understood. This study investigated whether there is a difference in rates of postoperative meningitis based on Staphylococcus aureus colonization and use of preoperative antibiotic prophylaxis. METHODS:All adult patients who underwent EEA resection at our institution from 2013 to 2021 were retrospectively reviewed. Patients with preoperative cerebrospinal fluid infections were excluded. Data including recent preoperative infections, preoperative colonization status, antibiotic administration, and postoperative outcomes were recorded for each patient. RESULTS:Of 483 patients identified (mean age, 51 years; range, 18-90 years; 274 [56.7%] female), 80 (16.6%) had a positive preoperative methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus (MSSA) screening swab. Twenty-one (26.3%) colonized patients were treated with preoperative decolonizing antibiotics. Within 30 days of surgery, 13 (2.7%) patients developed culture-positive meningitis. There was no significant difference in meningitis rates based on MRSA/MSSA colonization status. Among colonized patients, there was no significant difference in rates of MRSA/MSSA meningitis based on preoperative antibiotic decolonization. CONCLUSIONS:Postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.